Npo after ???

[stonemd]

Anyone have any experience with clear carbohydrate + protein drinks? Trauma and GI surgeons are ordering this the day of surgery. I'm not familiar with evidence of the rate of gastric emptying.

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[Noyac]

Seems odd but I'm probably tubing their pts anyway so I'm not so concerned. I'll take a stab at 4 hrs. Of course that is without any real evidence that I can think of off the top of my head.

 

[OB1🤙]

Hot off the presses-http://mobile.journals.lww.com/anesthesia-analgesia/_layouts/oaks.journals.mobile/articleviewer.aspx?year=2014&issue=06000&article=00017

 

[OB1🤙]

Cliffs: glucose containing drinks were gone from the stomach by 90 minutes after intake. In most subjects, glucose+ amino acid drinks were still present in significant quantity at 120 minutes.

Given that, I'd wait 4 hours.

 

[twoliter]

Cliffs: glucose containing drinks were gone from the stomach by 90 minutes after intake. In most subjects, glucose+ amino acid drinks were still present in significant quantity at 120 minutes.

Given that, I'd wait 4 hours.

I thought I'd remembered reading that (that glucose containing drinks emptied faster, but the addition of AA/protein slowed it down), but though "what do I know, I'm just a resident" after reading that those surgeons were ordering it. I'm sure there's a reason, but I'm hoping there not expecting the patients to be virtually drinking it on the way to the OR.

 

[BLADEMDA]

Anesthesia & Analgesia:
June 2014 - Volume 118 - Issue 6 - p 1268–1273
doi: 10.1213/ANE.0b013e3182a9956f
Critical Care, Trauma and Resuscitation: Research Report
The Effects on Gastric Emptying and Carbohydrate Loading of an Oral Nutritional Supplement and an Oral Rehydration Solution: A Crossover Study with Magnetic Resonance Imaging
Nakamura, Makoto MD*; Uchida, Kanji MD, PhD*; Akahane, Masaaki MD, PhD†; Watanabe, Yasushi†; Ohtomo, Kuni MD, PhD†; Yamada, Yo****sugu MD, PhD*




Abstract

BACKGROUND: Preoperative administration of clear fluids by mouth has recently been endorsed as a way to improve postoperative outcomes. A carbohydrate-containing beverage supplemented with electrolytes or proteins may have additional benefits for patients’ satisfaction. However, effects on gastric residual, nausea, and emesis and the effectiveness of these beverages for improving patients’ hydration status have not been well defined.

METHODS: We evaluated changes in gastric volume over time by magnetic resonance imaging, as well as blood glucose levels, before and after administration of 500 mL oral rehydration solution (ORS) containing 1.8% glucose and electrolytes in 10 healthy volunteers. The same volume of an oral nutritional supplement (ONS) containing 18% glucose and supplemental arginine (545 mOsm/kg) was given to the same population using a crossover design.

RESULTS: The mean (median, 95% confidence interval) gastric fluid volume at 1 hour after oral ingestion was 55.0 (55.3, 39.0–70.9) mL in the ORS group, whereas 409.2 (410.9, 371.4–447.0) mL in the ONS group (P = 0.0002). The gastric fluid volume of all participants in the ORS group returned to <1 mL/kg at 90 minutes after ingestion, whereas none reached <1 mL/kg at 120 minutes in the ONS group. The ONS group showed a sustained increase in the blood glucose level after ingestion (P < 0.0001 to baseline at 30, 60, 120 minutes), while the ORS group showed an initial increase (P < 0.0001, P = 0.01, P = 0.205 at each time point).

CONCLUSIONS: ORS supplemented with a small amount of glucose showed faster gastric emptying, which may make it suitable for preoperative administration. In contrast, ONS supplemented with arginine with a relatively low osmolality was associated with a longer time for gastric emptying, although it showed a sustained increase in blood glucose level.

 

[BuzzPhreed]

This is some new fad that is going to blow-up in their face. Have patience.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604918/

 

[DreamLover]

ERAS Enhanced Recovery After Surgery is big right now at my academic institution. It's a Protocol for elective colorectal cases-carb loading, no bowel preps, low fluids, tap blocks/epidurals etc. Is no one else hearing about this or currently practicing this?

 

[Noyac]

It makes sense to hydrate and nourish these pts before surgery. If you were going to participate in some strenuous activity For a couple hours, you wouldn't restrict your fluids prior to doing this would you? Having surgery can be equated to this.

 

[stonemd]

Looking at those 2 references I think I'll make it no less than 4 hours after clear liquid with protein/amino acid.

 

[BuzzPhreed]

It makes sense to hydrate and nourish these pts before surgery. If you were going to participate in some strenuous activity For a couple hours, you wouldn't restrict your fluids prior to doing this would you? Having surgery can be equated to this.

They make D5LR.

I'm not convinced the amino acids do much, except maybe protect the intestinal lumen during a belly case.

 

[WholeLottaGame7]

ERAS Enhanced Recovery After Surgery is big right now at my academic institution. It's a Protocol for elective colorectal cases-carb loading, no bowel preps, low fluids, tap blocks/epidurals etc. Is no one else hearing about this or currently practicing this?

We're big on ERAS at our institution, also. They've extended it out from elective colorectal cases to other big abdominal cases: cystectomy, nephrectomy, etc. I think the keys are the epidural and paying attention to volume status; not sure how much the Gatorade in the AM does.